Intraoperative Decision-Making: A Comparative Analysis of Scrape Cytology vs. Frozen Section in Eighty Consecutive Samples.

Abstract

Introduction: Intraoperative tumor evaluation is essential for optimizing surgical decision-making and can prevent the need for unnecessary radical surgeries. Although frozen section (FS) is the gold standard for such evaluations in advanced centers, scrape cytology presents a simpler, cost-effective alternative that could be beneficial in resource-limited settings. However, this technique is often overlooked in favor of FS due to greater pathologist confidence in FS.

Materials and methods: This study included 80 consecutive intraoperative samples from the Department of Pathology. Both scrape cytology and FS were independently evaluated, and results were compared with those of the final histopathology, taken as the gold standard. Statistical analysis assessed the concordance, sensitivity, specificity, and diagnostic accuracy for each method.

Results: Scrape cytology and FS demonstrated a concordance rate of 87.5%, with sensitivity and specificity of 89.3% and 90.4%, respectively, for scrape cytology. Positive predictive value was 83.3%, and negative predictive value was 94%. Scrape cytology significantly reduced diagnostic time, averaging 10 min compared to 20 min for FS. Tissue-specific discrepancies were noted, particularly in lymph nodes and parathyroid cases.

Conclusion: Scrape cytology proved to be a reliable, cost-effective, and time-efficient alternative to FS, especially in settings where FS is unavailable. Although FS remains optimal for architectural detail, scrape cytology provides high diagnostic accuracy and utility for intraoperative decision-making in resource-limited environments.